Explaining the Problem & the Symptoms : Fibromyalgia

Fibromyalgia is a condition characterised by generalised muscle pain, stiffness, and tender points in specified locations with accompanying sleep difficulties, morning stiffness and fatigue. There have been differing ideas as to why this problem starts and how it’s maintained, however there is still much to learn and understand. Despite this there is now good evidence to support the concept that fibromyalgia is a condition driven by a central nervous system (spinal cord and brain) that’s processing pain in a dysfunctional way. Pain science research has shown that we need to look at the function and changes that occur in the central nervous system in order to be more effective in managing chronically painful conditions, including fibromyalgia.

Similar to other persisting pains, there are often a myriad of other symptoms that are experienced, some of which may make no sense. One of the most important parts of managing and treating chronic conditions is to explain the nature of the problem and the reasons for the symptoms. ‘Explaining’ pain is fundamental in allaying fears and answering questions that are provoking fears and anxieties which alone can amplify pain as will be described. Understanding the influences upon pain and the factors that can aggravate will help in your self-management and enhance the treatment process. This has been evidenced by a study that looked at the effects of pain education on a particular test that’s commonly used in the clinic (straight leg raise). It was found that the test improved following an education session that focused on pain science.

This may easily be significant part of this specific issue. There have been many studies that have used brain scanning techniques to assess brain activity during the pain experience. The findings support a useful pain model called the ‘pain neuromatrix’ that was developed by Ron Melzack. This model described a network of nerves (neurons) in the brain that when active in a particular way would create the conscious experience of pain. The regions of the brain that form this matrix include areas that are responsible for control of movement, sensation, anxiety, memory, concentration, emotion, belief, planning and vision to name a few. Any one of these regions when activated can trigger the other regions through interconnections (the matrix), thereby initiating activity, a ‘neurosignature’, within the network. For example, seeing someone bending can provoke your back pain by the visual input from observing the movement stimulating activity in other parts of the matrix. We’ve a ‘neurosignature’ for all activities and thoughts, this being a pattern of activity within a network of neurons that’s responsible for our experience, e.g. Walking, speaking and writing. One region that’s particularly worthy of mention is the amygdala which is involved with fear and anxiety. Through its connections with other parts of the pain neuromatrix the amygdala can trigger the neurosignature for pain. This means that if you’re feeling fearful or anxious because of not understanding your symptoms for example, the pain can be amplified. In the light of this knowledge we can see that education about the condition and associated symptoms is fundamental.

Pain is a normal sensory experience that’s part of a protective response created by the brain (not the mind!) to motivate some action. This is the same as a thirst or hunger that motivates the action of seeking food or water for survival. Other components of this protective response include reflexive action (pull hand away from the fire), changes in blood flow and immune activity to promote healing. Often the tissue will heal after being damaged and the sensitivity that develops normally will ease. Sometimes this sensitivity reduction doesn’t occur and persists. This means that the tissues heal but the nervous system remains in an excitable state, sending danger messages despite the fact that there is no danger. Clearly the management of this type of problem is different and requires a ‘wide lens’ to consider the varying influences upon the pain experience; recall the pain matrix and the regions involved. With a chronic condition the treatment must focus on the activity of the central nervous system and the way in which it processes pain information. Normal movement and touch are painful because the processing of the information results in the brain believing there to be a threat to the tissues. We know that the tissues are actually not unhealthy but rather the nerves that supply the tissues are excitable and that the central nervous system is sensitive and these states mean that normal touch and movements are perceived to be ‘dangerous’. Changing the brain’s perception of this requires more than just tissue targeted treatment (e.g. Massage, joint mobility) with interventions such as education, coping skills, relaxation and tactile discrimination having a significant role. Some ‘hands on’ treatments are indicated and should be applied wisely alongside the aforementioned.

Science clearly tells us that pain is not an accurate indicator of tissue damage. Examples such as phantom limb pain and pain-free trauma suggest that the brain must prioritise the information from the tissues in the light of survival, and decide what action is most important. Stepping on a nail is usually painful, unless of course a bus is hurtling toward you when you’ll almost certainly run out of way despite the injury to your foot. This fact is significant in both understanding and managing pain in an effective way.

Suffering with the symptoms of fibromyalgia often means widespread pain, stiffness, tenderness in the tissues, fatigue and mood changes. The activity in the central nervous system underpins many of these symptoms and it’s vital that as a sufferer this is understood. Linked with the pain processing pathways are the activities of the immune system and stress physiology. This means that if you’re unwell the pain can be amplified by the increased release of immune chemicals that sensitise the nervous system. The cascade of hormone releases that occur as the body deals with stress (pain is a stressor) can also amplify the pain and be responsible for stiffness in the tissues, particularly in the morning. There has been much work done on both of these systems so we can understand the links between general health, sleep, mood and pain.

Fibromyalgia is a complex condition with numerous contributing factors. The understanding of the causes and pathology has greatly increased but we’ve much further to go. Treatment methods have fortunately advanced in tandem with the scientific knowledge

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